AskB4UCallMDhttp://askb4ucallmd.com
Get the answers before you see the doctorThu, 22 Dec 2016 14:00:51 +0000en-UShourly1https://wordpress.org/?v=4.9.6Getting Involvedhttp://askb4ucallmd.com/2016/12/22/getting-involved/
http://askb4ucallmd.com/2016/12/22/getting-involved/#respondThu, 22 Dec 2016 14:00:51 +0000http://askb4ucallmd.com/?p=25Although frequent visits are very important, you must also have continuous involvement. One way to stay involved is to join the facility’s family council, if there is one in place. If not, you might suggest forming one.

Family councils normally meet once a month in the facility to discuss issues of interest and concern. Council meetings provide an opportunity for family members to raise questions related to care with facility management. Family councils may also organize special events for residents, or generally work together to improve communications between staff and family with the ultimate goal of enhancing resident quality of life.

Also, the family council is allowed to organize letter-writing campaigns to legislators when there is a bill of concern to nursing facility residents before Congress or state legislatures.

]]>http://askb4ucallmd.com/2016/12/22/getting-involved/feed/0Possible Optionshttp://askb4ucallmd.com/2016/12/22/possible-options/
http://askb4ucallmd.com/2016/12/22/possible-options/#respondThu, 22 Dec 2016 14:00:14 +0000http://askb4ucallmd.com/?p=23Many can take for granted the fact that they live by themselves, whether the person is older or not. Many people move out of their parents’ house and move into an ―independent lifestyle‖ at some point in their lives. To most seniors, ―independently‖, means living in one’s own home, whether it is with or without financial support. Most of the time seniors will receive financial assistance from the children or others and there may even be an arrangement for a child or hired aid to help 2-3 days a week for 4 hours a day with chores, etc. In some cases, a live-in child or aid is necessary to assist with daily living activities. Regardless, the senior is given a feeling of control by living in his or her home, whether the home is a house in a retirement community, or any other home. They do not live in a room in the children’s home or in a community where the senior is expected to follow rules that affect basic choices, such as decisions about food, pets, transportation, relationships, and conjugal visits.

An assisted living facility can be defined as ―a form of housing arrangement that provides some assistance with activities of daily living.‖ In a broader sense it would be a group housing community with additional services, or more specifically, a facility that provides housing, and some level of personal care. The major difference is that the help with activities of daily living (ADL) occurs at the ―facility,‖ which can cause any senior to be scared. The term facility signifies a controlled environment. The Assisted Living Federation of America, a facility can cover a wide range of settings, care offerings, and residences. It could be anything from convenient high-rise apartments to converted Victorian homes, to campus communities with all the charms of a small town. The size of a residence can range form 25 to 120 units and can differ in size from a single room to a full apartment. All assisted living facilities are the same in that the resident is sacrificing his or her ―independent‖ living and some independence, in exchange for readily accessible assistance with daily activities. Even though this can help friends and family to be more comfortable with the senior’s location and well-being, it can be devastating for an elder.

In comparison to the fairly recent advent of assisted living facilities, nursing homes have existed in the United States from the early 1900’s when most states sent their impoverished citizens to poor farms or almshouses. Therefore, it is not out of the ordinary for a senior to view the idea of being put into a nursing home as negative.

Living arrangements are available that will combine parts of independent living, assisted living and nursing homes. Continuing care retirement communities represent a structure that offers varying levels of support, which can range from a senior living in his or her own room or apartment and making most daily decisions; to assisted living where the resident receives help with daily activities; to a nursing home that provides complete assistance. The most similar characteristic of these communities is that a resident can transition across the varying levels of care without leaving the community.

]]>http://askb4ucallmd.com/2016/12/22/possible-options/feed/0Financial Problemshttp://askb4ucallmd.com/2016/12/22/financial-problems/
http://askb4ucallmd.com/2016/12/22/financial-problems/#respondThu, 22 Dec 2016 13:59:49 +0000http://askb4ucallmd.com/?p=21Alternative housing raise different financial concerns, such as the decision to own or rent, the entrance fees and recurring monthly, quarterly, or annual fees are also of concern. The resident needs to know things like what is included in the costs charged by a facility or community, if there is a possibility for exposure to increases in costs, the role of Medicare and Medicaid and long-term care insurance and how it will benefit them, etc. Along with many more, these are some of the more important financial questions.

Medicare is a national insurance program for Social Security recipients who are at least 65 or disabled. Medicare pays for 20 days of nursing home care in full and will continue to pay a portion of the cost for the next 80 days. The resident is responsible for a copayment, which is currently at about $128.00 per day for days 21 through 100 each benefit period. On the other hand, there is Medicaid, which is a joint federal and state program and is the only public program available to pay for long-term nursing home care.

When trying to decide if to move a senior into alternative housing, all costs should be considered and can vary significantly. Covering these costs can be difficult and may need to be generated from various sources. Eligibility for Medicaid is a difficult question and it is recommended that one consult with professionals experienced in Medicaid law. Individuals have the option of looking into personal assets such as their home, which can be sold or rented out. They may also consider securing a home equity loan or reverse mortgage. Long-term care insurance, if owned, could be a major source of funding. Life insurance can provide funds by the owner cancelling a policy with cash surrender value, borrowing against the insurance policy, tapping into accelerated death benefits, or selling the policy. Deferred annuities that may be owned might be accessible early with no penalty. A disability insurance policy may be exchangeable for a long-term care insurance policy.

]]>http://askb4ucallmd.com/2016/12/22/financial-problems/feed/0Activities of Daily Livinghttp://askb4ucallmd.com/2016/12/22/activities-of-daily-living/
http://askb4ucallmd.com/2016/12/22/activities-of-daily-living/#respondThu, 22 Dec 2016 13:59:15 +0000http://askb4ucallmd.com/?p=19When discussing alternative housing arrangements, it is important to consider how capable the senior is of performing daily activities. Activities that should be considered usually include bathing, dressing, moving and feeding oneself. Most of the time, it is obvious when a person is fully capable and totally incapable of taking care of themselves, however, what becomes questionable is the area between being completely capable or incapable. The best person to make this call may be a physician, occupational therapist or social worker, and, they may make the decision individually or in conjunction with each other. However, even their evaluation may be challenged, especially by the individual being judged.

While attempting to determine if a senior is able to perform daily activities, some good evaluation tools are the Dependency Scale and the Barthel Activities of Daily Living Index (Barthel Index) (Refer to rating scales in following pages). The Barthel Activities of Daily Living Index is highly recommended; however there have been some uncertainties about the reliability when it is used on the elderly. The Barthel Index addresses ten items – eating, bathing, grooming, dressing, bowels, bladder, toilet use, transfers from the bed to the chair and back, mobility, on level surfaces and stairs. There is a score that goes with each response and there are ranges set based on those scores to determine the independence of each person. For example, 80-100 is the independence range for men.

There are some objective guidelines to assist physicians and others in making a decision; however, there is also a lot of subjectivity and professional judgment involved. In addition to evaluating a senior’s ability to perform daily activities, judgment has to be used to assess a senior’s cognitive impairment or other mental issues. Something to consider is if children are able to determine a parent’s ability to perform activities of daily living. A major concern is the senior’s assessment, assuming that they are of sound mind to do so, which is another judgment that needs to be made. A common question is how to determine if a senior is of sound mind. Many turn to lawyers and judges, but who is to say that they are able to determine how much assistance is needed.

]]>http://askb4ucallmd.com/2016/12/22/activities-of-daily-living/feed/0Psychological Aspectshttp://askb4ucallmd.com/2016/12/22/psychological-aspects/
http://askb4ucallmd.com/2016/12/22/psychological-aspects/#respondThu, 22 Dec 2016 13:58:19 +0000http://askb4ucallmd.com/?p=17Falls can drastically change many people’s lives. It is usually a time when change is inevitable. The senior can go living independently and performing daily activities alone or with the limited assistance, to needing a walker and not being able to dress themselves, etc.

Accepting one’s limitations as you get older is a very difficult thing to accept, and in many cases can cause people to go through the often talked about, stages of grieving. Those stages include denial, anger, bargaining, depression, and acceptance. It is not unlikely that these stages apply, especially the denial, depression, and anger stages, and mourning the loss of control and independence brought on by age, etc.

A son/daughter assisting in the making of decisions is not an uncommon, and can tend to be a very difficult process. It is especially difficult when the child has the power of attorney to make a choice. At this point, it is their responsibility to make a decision in the best interest of the parent and to select an arrangement that will provide the safest and most comfortable setting for the parent. The same attitude is usually used when they do not have the legal right to make a decision and the problem becomes convincing the senior to make the same choice, which especially difficult when the senior may be the only one legally empowered to make that choice.

It is for all parties, especially the children, to be supportive and acknowledge the issues that the parent may be experiencing. The parent may be angry, depressed, and may even be having suicidal thoughts. The child should consider recruiting trusted professionals, including the senior’s physicians, occupational and physical therapists, social workers, and psychologists who can meet with the senior individually and/or jointly. Family members and friends could play a role by presenting a consistent stream of recommendations that basically conclude that the time has come for the senior to consider alternatives to the type of independent living that he or she has grown accustomed to, then there is a strong likelihood that change will be easier to make and it will ultimately be the senior’s decision. It is important to focus on the advantages of a continuing care retirement community, assisted living or a nursing home. Provide the senior with options, such as a temporary arrangement where the senior is able to try a community or facility or home before making an official commitment.

]]>http://askb4ucallmd.com/2016/12/22/psychological-aspects/feed/0Quality of Life in LTC’shttp://askb4ucallmd.com/2016/12/22/quality-of-life-in-ltcs/
http://askb4ucallmd.com/2016/12/22/quality-of-life-in-ltcs/#respondThu, 22 Dec 2016 13:57:10 +0000http://askb4ucallmd.com/?p=15The Nursing Home Reform Act was the start of the focus of reforming the regulations in nursing homes to improve on the quality of life of the residents. Over time it has expanded to a much larger focus, with a goal of creating a culture of aging that is life affirming, enjoyable, humane, and meaningful.

Many of the changes have been addressed in the revisions of the Centers for Medicare and Medicaid Services (CMS) in 2006. One important focus is that the facility is required to provide an ongoing program of activities which should meet the interests of the resident along with the physical, mental, and psychosocial well-being of that resident. Another focus is on what is called the ―person appropriate‖ activities which are relevant to specific needs, interests, culture and background of individual residents. One-on-one programming requires the caregivers to assist those who are incapable of organizing and planning their own activities, like patients with dementia. The program designed for each patient should be a combination of large and small groups, one-on-one, and self-directed activities on a daily basis.

The changes focus on the need for the program to contain daily activities that are associated with the patient’s interests, capabilities, and preferences and that the program is implemented in an environment that is likely for success.

Language that is specific to persons with dementia stresses the importance of the staffs’ role in identifying, implementing, monitoring, and evaluating activities and plans for residents to be certain that their needs are met and to determine if changes are necessary.

Training for Encouraging Activity Participation
There are many long-term care facilities that require the assistance in understanding their options for activities and to focus on the mission of quality of life for residents and regulatory compliance. This training specifically focuses on the needs of a patient who suffers from dementia, especially those whose problems affect their communication, problem-solving, and initiation of activities.
The first step to take when modifying programs for dementia patients is to have an understanding of how dementia-related changes may influence the approaches required to meet activity needs and preferences. Some research must be done on the patient to gather important information about them like understanding cognitive losses that are dementia related, which can include showing interest, identifying and planning activities, and remembering how to do activities. It is also extremely important to comprehend the association between behavioral and psychological symptoms of dementia (BPSD), which is very important for daily care providers to understand.Theory-Driven Activity Involvement
A certain model can be followed to provide an important framework for understanding how caregivers can change their daily routine to avoid chances of BPSD. This model is known as, The Need-Driven Dementia Compromised Behavior (NDB) model. The NDB model proposes that BPSD are the direct outcome of background factors, such as cognitive abilities, health status, and psychosocial factors, and more changeable proximal factors, such as psychological and physiological needs and quality of the physical and social environments.
The NDB model has background factors that represent a profile of strengths, weaknesses, and usual coping style. Activities that are based on the NDB model will match the patients’ current level of cognitive and physical functioning capabilities to ensure that they are at a level that allows them to participate. Activities will also go with the patients’ personality and interests. Matching the background factors to the proximal factors provides an essential structure for daily care providers.Applying the Methods
According to the NDB model, the type and frequency of activities of a dementia patient are highly similar to the occurrence of BPSD. There more cases than there should be of dementia patients being left alone, having nothing to occupy their time. Deficiencies associated with dementia, such as the use of language, cause issues in their participation in activities. Large group activities should be avoided with dementia patients for several reasons. Larger groups are normally too complex for their level of cognitive functioning, there may be few similarities with their current interests, or the sessions might just be too long for them to handle.
It is very important that the caregivers know the patient very well in order to organize activities appropriate for that specific patient.Activity Options: Many Choices
In addition to being familiar with the patient, caregivers also need help in thinking of creative ways to keep dementia patients occupied with activities. Research shows that a wide range of recreational therapy interventions is beneficial to persons with dementia. The NEST (Needs, Environment, Stimulation, and Technique) approach, described by Buettner and Fitzsimmons, has shown to be very helpful with over 80 therapeutic protocols that make up 10 different categories, such as feelings, nurturing, relaxation, adventure, physical exercise, cognitive, life roles, psychosocial clubs, and basic pleasures.
The goal of recreational therapy interventions are to minimize identified BPSD and are mostly used in long-term care settings. The NEST approach recommends forming a team of long-term care staff, made up of at least a nurse and recreational therapist, who should meet once a day to focus on the needs of the dementia patients. Some possible topics of discussion can be to assess behaviors, determine what needs have been overlooked, adjust the surroundings to promote function, complete baseline assessments, and to determine activity procedures according to the individual.
The following examples have been tested by Buettner and Fitzsimmons and are explained in more detail in their NEST manual. The major outcomes of these studies show that through the use of therapeutic recreation interventions, individuals with agitation showed signs of more calm behavior (92-100% of the time) and patients with passive behaviors were more alert (79-91% of the time).Simple Pleasures
Simple pleasures are seen as a starting point for formulating activities that may be used by inactive personnel throughout the day through a group multilevel sensorimotor interventions. Simple pleasures can be used for many purposes, such as passive behaviors, boredom, or even agitation. The amount of ―pleasure‖ is determined by the time that is spent on the task, affective responses, and behaviors. For example, these may include changing those who are passive to be alert and actively participating, or distracting or calming agitated patients. These interventions are meant to be used in small groups or in a one-to-one session and can last anywhere from 5-45 minutes.Adventure-Based
Wheelchair biking is a very beneficial way of offering considerable opportunities for persons with dementia by combining small-group activities with rides on a Duet bike. Group discussions include questions about past experiences with riding a bike, such as, ―How old were you when you first rode a bicycle?‖ or ―Do you remember what color it was?‖ There are two parts to the Duet bike: a wheelchair and a bike that connects to the wheelchair, allowing the trained therapist to pedal and steer the bike while the patient rides along in the wheelchair. Last, the patients will tell others in the group about their ride.Life Roles
These activities are more focused on real life situations that most have had experience with before and possibly miss. Therapeutic Cooking is a good family-like intervention that may simultaneously stimulate cognitive skills, improve motor functioning, and reduce anorexia. The activities may include things such as, planning menus, gathering food for the meal, using equipment to prepare food, and indulging in the baked items or meals in a group. Other activities that might be combined with cooking include, gardening, setting or decorating the table, and engaging in conversation about past experiences or current interests.Physical-Based
Involving dementia patients in several types of physical exercises and/or activities is associated with improved sleep, function, and mood, which will help decrease restlessness and wandering. A commonly used intervention is Exercise for Function, which is a planned physical activity that focuses on range of motion, as well as endurance and strengthening. These exercised are choreographed to music and include exercises from the head all the way to the feet and last about 20 minutes.
Another program is focused on those who wake up early, called the Early Risers Walking Club, which last for about 30 minutes and is conducted five days per week.Cognitive-Based
The Price Is Right Game can be used to improve on several different areas, such as cognitive stimulation related to guessing prices, appetite stimulation related to thinking about food, socialization by discussing food and their prices, and as a means to engage residents who tend to wander away from the dining room before meals. During small-group intervention, therapists will hold up two food items and which one costs more, then they reveal the actual price and begin a discussion about the price and whether or not it is fair.
Dominoes are another cognitive-based program that can be helpful to dementia patients. Normal rules can be used when playing with higher functioning residents, while mid-functioning residents may use them to set up on their edges and topple them over, and lower-functioning residents will benefit from color-matched dominoes or ones with large pictures.Psychosocial Club-Based
There are all kinds of club-based activities to get involved in, all of which focus on the different interests of residents, such as birds, bowling, cars, golf, weather, etc. These programs involve patients in small-group socialization, discussion, and activity engagement which are aimed at reducing depression, social isolation, passiveness, sensory deprivation, restlessness, and wandering. Depending on the activity, these meetings usually last about 30-45 minutes and are held 1-2 times per week.Nurturing
These interventions help residents by promoting caring or nurturing behaviors through activities involving animals. These interventions may benefit residents in several ways whether it be social, motivational, educational, or recreational. Some of the Animal-assisted methods used are Animal-Assisted Activities (AAA) and Animal-Assisted Therapy (AAT).
Each AAT session involves three major parts: 1) the approach, in which visual and verbal contact is made between the animal and the resident, 2) the process, in which the animal-resident interaction is focused on meeting certain predefined goals, and 3) the closure, in which the resident rewards the animal and accomplishments are reviewed.Teamwork: Making it Work
Teamwork is a very important part of making the activity programs and therapies effective. Research has shown that the success of these programs is more likely when a team has been formed.
Success is also dependent upon building on the strengths and weaknesses of all team members. It is important to use the team members’ natural interests and skills to form and maintain the programs.
Teamwork also involves helping staff members appreciate and assist with common aspects of activity involvement, like helping residents be dressed appropriately for the program, like wearing the appropriate shoes or wearing sunglasses.
It also important that daily staff providers are familiar with the programs and how to execute them because activities can be scheduled for any time of the day, every day of the week. This makes it critical that the staff works together and is able to transition residents from one activity to another and be familiar with each individualized program that they have developed for each resident.Summary
The 2006 activity revision offers important opportunities to move forward in the value of cultural change. Successful and appropriate programs are dependent upon the cooperation and assistance of all team members, a basic working knowledge of dementia processes, and a sound knowledge of innovative, evidence based activities that coincide with the interests and abilities of each resident. One of the first steps in the success building an interdisciplinary team is developing an ongoing training program that trains the staff and constantly updates them on new discoveries associated with dementia and activity interventions.

]]>http://askb4ucallmd.com/2016/12/22/quality-of-life-in-ltcs/feed/0Reducing Psychotropic Drug use is Easyhttp://askb4ucallmd.com/2016/12/22/reducing-psychotropic-drug-use-is-easy/
http://askb4ucallmd.com/2016/12/22/reducing-psychotropic-drug-use-is-easy/#respondThu, 22 Dec 2016 13:56:27 +0000http://askb4ucallmd.com/?p=1367.7% of assisted living residents have dementia and 26.3% have an active non-cognitive psychiatric disorder. Screening has been found to be helpful in assisted living facilities and nursing homes.
Research shows that in nursing homes with treatment:

51% of participants with dementia and depression did improve their quality of life.
58% of those with depression alone, receiving counseling and medication recovered six months later and had a better quality of life.
Only 25% of those receiving medication alone improved, but did not have a significantly better quality of life.
Patients need to be seen 1-4 times per month in order to monitor-the constant fluctuation of behavioral and psychiatric symptoms and medical problems. Post stoke depression usually resolves in 6 months but can last two years.

In conclusion, patients who received psychotherapy (counseling) did 100% better than those that received medication alone. They also had a significant decrease in behavioral problems sooner and a better quality of life for longer.

]]>http://askb4ucallmd.com/2016/12/22/reducing-psychotropic-drug-use-is-easy/feed/0Why Do We Do Screeninghttp://askb4ucallmd.com/2016/12/22/why-do-we-do-screening/
http://askb4ucallmd.com/2016/12/22/why-do-we-do-screening/#respondThu, 22 Dec 2016 13:55:44 +0000http://askb4ucallmd.com/?p=11This tool was developed to aid primary care clinicians in caring for their patients who suffer primarily from Dementia and Alzheimer’s. However , many of the tools will also be useful for managing chronic depression and minor depression, secondary to Dementia and Alzheimer’s. The care management process recommended here builds on the earlier guidelines from the Agency for Health Care Policy and research (AHCPR)- now known as the Agency for Healthcare Research and Quality (AHRQ)- which have been updated and adopted from other evidence based sources including recently published multi-site trials and current studies.

Quick Facts About Psychological Counseling
In psychological counseling, patients with depression work with a qualified health care professional who listens to them, talks and helps them correct overly negative thinking (which reinforces depressed mood) and improve their relationships with others Psychological counseling for depression is not talking about your childhood, but rather focused on current concerns and ways to address them.

]]>http://askb4ucallmd.com/2016/12/22/why-do-we-do-screening/feed/0Treating Depression with Psychological Counselinghttp://askb4ucallmd.com/2016/12/22/treating-depression-with-psychological-counseling/
http://askb4ucallmd.com/2016/12/22/treating-depression-with-psychological-counseling/#respondThu, 22 Dec 2016 13:55:03 +0000http://askb4ucallmd.com/?p=9Psychological counseling has been shown to be effective as antidepressants in treating many people with depression. Psychological counseling can be done individually (only you and a mental health professional), in a group (a mental health professional, you, and others with similar problems), or it can be family or marriage counseling where a mental health professional, you and your spouse or family members participate.
More than half of the people-with mild to moderate depression respond well to psychological counseling. While the length of time that persons are involved in counseling differs, people with depression can typically expect to attend a weekly hour-long counseling session for 6- 20 weeks.
If your depression is not noticeably improved after 6-12 weeks of counseling, this usually means that you need to try different treatment for your depression. Psychological counseling by itself is not recommended as the only treatment for persons whose depression is recurrent, more chronic, or severe. Medication is needed for those types of depression and it can be taken in combination with psychological counseling.
]]>http://askb4ucallmd.com/2016/12/22/treating-depression-with-psychological-counseling/feed/0Information for Clinicians, Administrators, and Primary Care Physicians about Screeninghttp://askb4ucallmd.com/2016/12/22/information-for-clinicians-administrators-and-primary-care-physicians-about-screening/
http://askb4ucallmd.com/2016/12/22/information-for-clinicians-administrators-and-primary-care-physicians-about-screening/#respondThu, 22 Dec 2016 13:49:55 +0000http://askb4ucallmd.com/?p=7SPC believes that our integrated Model of Care (psychotropic management and therapy) and protocols developed over the years can provide your families with a distinct advantage in day-to-day operations resulting in a higher quality of care for your residents.
The integrated Model of Care stresses regulatory compliance for long-term care facilities by addressing medical management (F-329, F-4290), assessment, and administrative tag (F-501).
Reduction in medications result in reduced falls and engage residents in more activities of daily living. This results in better participation in psychotherapy modules and behavior modification provided by higher training psychologists and therapists adhering to our protocols to further the quality of life of your clients.
When residents respond to mediation and therapy, hospitalization is therefore reduced resulting in higher occupancy for the facility.

As you are aware, the more engaged the residents, the less prone to agitation they become. This reduces stress on your caregivers and turn over. You are able to attract and retain happier staff and other clinical members of your facility. With stable occupancy and staff, it is easier to plan for staffing and scheduling. Educating physicians, family, and the general public are also part of our responsibility.

If we can be of any assistance to you, please do not hesitate to contact any of us. We look forward to working with you.